Senior Business Analyst - Care Management

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Full time

10-15 years

70%

Bachelors degree

 

Projé has an exciting opportunity for a fulltime Senior Business Analyst.  This position requires Monday through Thursday travel to the client site in Tennessee.   The Senior Business Analyst will assist in the assessment, analysis, documentation and testing process for the Health Plan Care Management Clinical Operations division.  The ideal candidate will possess detailed knowledge of claims, clinical editing, case management, disease management, utilization management, and enrollment.

We offer a strong team environment where we are committed to each other, our clients, and excellence.  Projé also offers competitive wages and recognition for outstanding performance.  Join our team today! 

 

  • Conducts the analysis and documentation of current state and future state, documenting gaps and user requirements in the design of the future state workflows, to optimize system functionality. Along with the client, modifies or creates new workflows and testing to improve processes.
  • Facilitates and elicits requirements for projects, while effectively managing changes and conflicts during specifications gathering process.
  • Develops use cases, test scenarios, test cases, clearly communicate testing methodologies and apply testing methodologies to ensure application quality.
  • Manages Clinical Business Process Modeling/Workflows utilizing Microsoft Visio
  • Develops and documents Desk Level Procedures and Standard Operational Procedures
  • Handles all aspects of Clinical Care Advance system including My Work Assignments, UM Case Entry and Inquiry, Validation and Business Rules, Letters, Progress Notes, CM Case Entry and Inquiry, Care Plans, Guidelines, Milestones, Goals, Interventions, Barriers, Outcomes, Problems, etc.
  • Participates in meetings and presentations effectively and professionally.  Provides documentation for meetings to report progress, issues and possible resolution.
  • Supports clinicians, managers, project managers and end-user timelines for assigned tasks

Key Qualifications

  • Solid understanding of health plan (payer) clinical operations in the health insurance space
  • In-depth understanding of Case Management, Disease Management, and Utilization Management
  • Knowledgeable in Healthcare Effectiveness Data and Information Set, Utilization Review Accreditation Commission, and National Committee for Quality Assurance
  • Strong analytical, problem solving, negotiation and collaboration skills.
  • Proven ability to participate in several projects at the same time.
  • Expert skills with MS Office Suite, Visio, MS Project, and SharePoint required.
  • Experienced in Commercial Lines of business as well as Medicare, Medicare Advantage, and Medicaid.
  • Clinical Software Implementation experience preferred.

Perks

  • Competitive pay and bonuses
  • Excellent benefits (medical, dental, vision)
  • 401K with percentage company match
  • Paid holidays and vacation days
  • Flexible schedule

Education and Experience

  • A minimum of 10 years of Clinical Operations and Health Plan experience is preferred.
  • A Bachelor’s degree in Healthcare Administration or a related field is required.  Equivalent experience may be considered in lieu of a Bachelor’s degree.

Salary will be determined based on qualifications, experience and specific project budgetary constraints.

$90000 - $150000 Yearly

  • United States, Tennessee, Nashville, Postal Code: 37214

 
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